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FRI0022 Rapid and sustained remission contributes to improved psychosocial outcomes after 1 year of treatment in patients with early rheumatoid arthritis: data from the carera trial
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  1. K. Van der Elst1,2,
  2. P. Verschueren1,2,
  3. V. Stouten2,
  4. S. Pazmino2,
  5. D. De Cock2,3,
  6. J. Joly1,
  7. P. Moons4,5,
  8. R. Westhovens1,2
  1. 1Rheumatology, University Hospitals Leuven
  2. 2Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium
  3. 3Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
  4. 4Centre for Health Services and Nursing Research, KU Leuven, Leuven, Belgium
  5. 5Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden

Abstract

Background The goal of early rheumatoid arthritis (RA) treatment is to reach remission as soon as possible, as this initial treatment response is a strong predictor of long-term clinical outcomes. Rapidly reaching remission is not only clinically meaningful, it also matters from the patient’s perspective.1 Yet, the influence of an initial response on patients’ future psychosocial functioning remains understudied in early RA.

Objectives To explore the association between the initial clinical response of patients with early RA and their psychosocial functioning after 1 year of treatment.

Methods We included patients with early RA (disease duration ≤1 year) who started first-time treatment within the Care in early RA (CareRA) trial.2 Based on the speed of response defined as the response at week 16, and the stability of response evaluated from week 16 onwards until week 52 of treatment, we created 4 profiles of initial clinical response relevant to patients: persistent responders, secondary failures, delayed responders and non-responders (table 1). Having a response was defined as a disease activity score (DAS28CRP)<2.6 indicating remission. Psychosocial functioning was operationalized using relevant subscales of the Short-form 36 (SF-36) and the Revised Illness Perception Questionnaire (IPQ-R) (table 2). We built multiple linear regression models for each psychosocial outcome separately adjusted for confounding variables. Imputation using the Expectation-Maximisation method was performed for missing SF-36 and IPQ-R scores (range 22.2%>23.1%) only at week 52.

Results The 333 included patients shared typical characteristics of an early RA population (69.5% being woman, mean(SD) age of 52.3 (13.0) years), with no differences in demographics between patients for the different response profiles. In almost all regression models, the initial clinical response profiles were identified as significant predictors for each psychosocial outcome at week 52 (table 2). A rapid and sustained response, when compared to having a relapse after initial response or a delayed response or no response at all, resulted in higher vitality, less interference with normal social activities, less problems with work or other daily activities because of emotional problems, an improved mental health, more positive beliefs about disease consequences, a higher belief in the effect of treatment, and a more coherent illness understanding.

Abstract FRI0022 – Table 1

Definitions of the self-created profiles of initial clinical response throughout the first year of treatment in patients with early rheumatoid arthritis.

Abstract FRI0022 – Table 2

The contribution of the initial clinical response to psychological outcomes (patient-reported) after 1 year of early RA treatment.

References [1] Van der Elst K, et al. Arthritis Care Res (Hoboken)2016;68(9):1278–87.

[2] Verschueren P, et al. Ann Rheum Dis. 2017;76(3):511–520.

Disclosure of Interest None declared

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